Healthcare Provider Details

I. General information

NPI: 1144183039
Provider Name (Legal Business Name): ABBEY FOWLER LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 KENMOOR AVE SE STE 103
GRAND RAPIDS MI
49546-8626
US

IV. Provider business mailing address

4524 MORNINGSIDE DR SE
KENTWOOD MI
49512-5336
US

V. Phone/Fax

Practice location:
  • Phone: 616-320-1711
  • Fax:
Mailing address:
  • Phone: 616-745-5402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024392
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: